This site is intended for health professionals only

At the heart of general practice since 1960

mayur lakhani

  • If, when and how to use FeNO

    mayur lakhani's comment 02 May 2018 12:14pm

    Mike, I really enjoyed this article and learnt and lot from it. Keep up the good work. I am strong supporter of higher clinical standards and clinical excellence in general practice and this sort of leadership helps towards innovation, especially in the context of the disturbing number of deaths from asthma.

  • The top five practice-changing papers of 2017

    mayur lakhani's comment 05 Dec 2017 2:15pm

    How good is this? Very useful Thank you for this selection

  • PSA-based screening reduces deaths from prostate cancer, finds new review

    mayur lakhani's comment 05 Sep 2017 8:59am

    There is a useful shared decision making aid on this PSA testing

    https://www.evidence.nhs.uk/Search?om=[{%22ety%22:[%22Patient%20Decision%20Aids%22]},{%22srn%22:[%22NHS%20RightCare%22]}]&ps=50&q=psa

  • Patient safety at risk unless NHS creates 'right working environment for GPs'

    mayur lakhani's comment 25 Aug 2017 11:40am

    Retired GP, I could not agree more, ie. to treat the causes. thank you. Your list is very helpful and I will use it, if I may. clear that multifaceted strategy and interventions needed all of which take time, but really urgent situation now as we hemorrhage GPs especially the 'last 5'

  • Patient safety at risk unless NHS creates 'right working environment for GPs'

    mayur lakhani's comment 25 Aug 2017 10:23am

    This is a really important issue.my thoughts today are with the thousands of practices up and down the country (I am on call today as well!) who are working very hard in difficult circumstances with an under-resourced general practice and fragmented rest of NHS (whilst the promising transformation/ integration initiatives take time to embed).

    There has to be a better way forward. I really care about this issue. Burnout prevention is really important and a key skill that should be taught from medical schools onwards. I know some GPs and practices have found really good ways of managing these issues. Please send me any examples and or submit to bright ideas at RCGP.

    In the mean time these resources are very helpful.There are other similar resources.

    https://www.thehappymd.com/

  • An overseas GP recruitment drive is not enough

    mayur lakhani's comment 24 Aug 2017 10:56am

    Samira

    An important contribution, thank you
    look forward to collaborating working with you
    at some stage

    Mayur Lakhani

  • Patient death was 'knock-on effect' from lack of GP resources, says coroner

    mayur lakhani's comment 16 Aug 2017 5:01pm

    GPs contact me regarding the need for much more support from mental health services. Specialized services tend to have narrow referral criteria for acceptance and often are not integrated within themselves e.g. addiction services/IAPT/Mental health/CRT team/ transitions with patients falling between gaps and increasing pressure on overstretched GPs services
    how about 'CPN' type role based in primary care localities - generalist role

  • Bramall’s five commandments for new GPs

    mayur lakhani's comment 03 Aug 2017 11:00am

    I agree taking care of yourself is really important

    'HALT' is useful

    Patient safety incidents more likely if you are

    Hungry
    Angry (often resentment)
    Late
    Tired

    Be aware of how you are feeling, if HALT stop and take a break

    other tips

    avoid over-investigation for 'reassurance'- does not work

    use time and watchful waiting

    continue to develop/ have a confident approach to problem solving e.g. diagnosis and decision making e.g. most likely, less likely, rule out

    ensure knowledge of local referral pathways usually

    problems sometimes arise because doctors are uncertain of their role-helpful framework
    e.g. three part role contact me for more information

  • Offer statins to patients with CKD, NICE advises

    mayur lakhani's comment 28 Jul 2017 7:39am

    Agree with GoneDoc. This is to be welcomed and is good preventative medicine with use of Statins in high risk patients. Clinician get nervous deviating from guidelines but in my experience GPs are good at selecting patients and using guidelines judiciously and they appreciate that guidelines are just that and not 'tramlines' by shared decision making

  • The information - hidradenitis suppurativa

    mayur lakhani's comment 23 Jun 2017 10:25am

    terrific article, this has helped me Fiona thank you as I have several cases in our practice. The psychological and social impact is huge. It is good to know that there is much more that can be done and careful treatment planning and liaison with specialists is key. One patient is being consider for biologic treatment.

  • Professor Mayur Lakhani elected RCGP president

    mayur lakhani's comment 01 Jun 2017 1:52pm

    Hello DT (| GP Partner/Principal01 Jun 2017 11:21am)

    I am sorry you feel that the RCGP is not relevant to you. I would like to try and change your mind! The College is open to feedback and criticism. I do appreciate that like any large membership organisation, we have not got everything right and there will be members who will not be happy

    I can give examples of achievements that can be traced back to the Royal College of General Practitioners e.g. 10.7% of NHS budget funding for general practice, the clinical pharmacy scheme, a world class specialist training scheme, invention and roll out of significant event auditing (Prof Mike Pringle)- the latter you will be using regularly in your practice and will be used daily somewhere in the UK.

    Is this enough? No not by any means. There is much more to do. So that you know, I stood for election as a working GP so do understand the reality of general practice.

    Let me know if you would like discuss more as I for one would hope that you will support us. Direct message me or you can also contact your local representative. Please keep an open mind It is your college! Seek change if you are unhappy -this is what the national elections are for!

    Kind Regards, Mayur Lakhani

  • Professor Mayur Lakhani elected RCGP president

    mayur lakhani's comment 01 Jun 2017 1:47pm

    Thank you to Pulse for featuring this. I would like to take this opportunity to thank Members of the RCGP throughout the UK and in the International Faculty for electing me to be their next President. This is a responsibility that I will take very seriously. I would like to thank all the other candidates who also stood in the election and from whose perspectives I have learnt a lot. Now the hard work begins! It will be a privilege to be a national leader whilst continuing my work as a local GP and clinical lead in ongoing efforts to transform health and care. I look forward to working with the Chair of the RCGP and its other Officers, Members and Faculties to move general practice forwards.
    I will do my very best to represent GPs’ interests – the President is the only officer directly elected by Members. Like any large membership organisation, I appreciate that there are GPs who do not always agree with the RCGP. I want to reassure colleagues that the College is open to feedback. And I know there is so much more to do to sustain general practice. At this critical time for general practice, we need to come together as GPs. Unity will help us tackle our challenges as there is a greater need than ever for strong professional leadership.

    If you have an idea you would like me to consider than please do not hesitate to contact me

    Mayur Lakhani

  • We need to stop prescribing antidepressants in primary care

    mayur lakhani's comment 23 May 2017 11:04am

    I agree that there is now with over-medicalisation of adjustment disorders. As a practising GP, it is hard to access timely high quality CBT. Des's columns are provocative and they make important points about the direction of modern medicine and public health. There is big need for CBT access.

    However I cannot agree that antidepressants should not be prescribed in primary care. If used judiciously for selected patients, they can be transformative. Shabi Nabi's point about (core symptom) anhedonia is key. Risk assessment for suicide is also necessary. Let us not throw the 'baby out with the bathwater'.Where evidence may be conflicted, I would would urge GPs to be safe and consider using guidance in BNF or at CKS/NICE

    What do others think?

  • Two thirds of GPs experience abuse from patients as rates rise

    mayur lakhani's comment 18 Apr 2017 6:52am

    This is very concerning speaking as someone who has experienced one episode of physical abuse and several examples of verbal abuse as a practising GP. There is very little support and you have 'get on with it'. As a GP appraiser I have met some doctors who are so abused and feel attacked by patients that they want to know if they can complain about a patient sometimes due to racist language. This combined with the spectre of complaints (with multiple jeopardy) that results in the 'second victim' syndrome, no wonder that morale and well being is at an all time low as GPs do not feel supported and the scales are balanced against them. There is evidence that GMC investigation of complaints leads doctors to practice defensively, hedging decisions, avoiding complex work with in the majority of cases, exoneration.

    Having said all that the context of this must be understood. In my view despite my bruising experiences, most patients are reasonable and understand very much the pressures we work under and support GPs if they are in the know. It is not their fault if their reasonable demands and expectations of modern medicine cannot be matched by the struggling services.

    It is a perfect storm for frustrations to be expressed whose first victim is loss of empathy all round. The current system does not serve patients, GPs or consultants well.

    We must find a way forwards. I think we can do this. First step is even stronger leadership from doctors and professional organisations and partnerships with patients to pursue a progressive agenda

  • Over two-thirds of GPs plan to leave or reduce hours, finds DH-backed study

    mayur lakhani's comment 12 Apr 2017 3:22pm

    Could we for example develop measures by which general practice can sensible control/limit its workload

    with an overflow to hubs

  • Over two-thirds of GPs plan to leave or reduce hours, finds DH-backed study

    mayur lakhani's comment 12 Apr 2017 2:58pm

    These are in many ways manifestations of burnout due to excessive workload, complexity, multimorbidity, constantly 'giving' and lack of support services compounded by fear of complaints and defensive practice

    Given all this, we should be very proud of how much we are achieving and delivering

    But Somehow we must find a way forward
    as this is not sustainable

    How can we 'keep general practice brilliant'*

    I was very impressed with the RCP project on *keeping medicine brilliant'

    Here an evidence base was defined was action including Eight ‘domains’ of a doctor’s working life

    Workload
    Physical environment needed for work
    Interpersonal relations in the workplace
    Hospital administration and policies (read practice)
    Personal characteristics
    Career, education and training
    External/home circumstances
    Patient safety

    There is no magic bullet but I believe there are opportunities so we can use our initiative to improve morale and wellbeing in a holistic way

    stronger national and local strategies and actions are needed

  • Selling Viagra widely in pharmacies ‘will deny men proper care’, warns top GP

    mayur lakhani's comment 11 Apr 2017 10:25am

    I appreciate and understand the concerns here but is this an issue that we should go to battle over?

    I wonder if there is a different way of looking at this specific issue. In years of evaluating and managing ED in general practice, it is very unusual to come across a game changing diagnosis or reversible factors although of course these do occur. Many patients with the condition will be well known to their practices through long term conditions management.

    Treatment is generally safe in carefully selected patients and I feel current arrangements are a barrier to getting treatment for what is for many a distressing and stigmatising condition.

    Why not remove barriers and allow a highly skilled pharmacists to assess and supply treatment. This would be in keeping with enabling self care and self management and more patient responsibility. Apart from anything else, the current workload pressures mean prioritisation and we should be looking for areas where pharmacist can help us out

    What do others think?

  • We need to talk openly about death

    mayur lakhani's comment 03 Apr 2017 3:58pm

    Excellent article
    this website contains resources for GPs to support discussions about death, dying and bereavement including triggers for initiating discussion
    http://www.dyingmatters.org/gp_page/breaking-news

  • GP practices will not be funded to employ therapists despite GPFV pledge

    mayur lakhani's comment 17 Mar 2017 10:21am


    I strong support the RCGP stance. Current mental health services are not well integrated with general practice whilst practice workload particularly in supporting patients with mental health problems and dual diagnosis is rising inexorably. Restrictive criteria and 'turf' wars between different services abound.
    The practice as a hub of integration is a key principle which we must adhere to

  • Should GPs be more positive to attract the next generation?

    mayur lakhani's comment 01 Mar 2017 10:11am

    excellent debate, I am more persuaded by Dom